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At the heart of general practice since 1960

GPs stop PMS cash going to GMS practices

BP not controlled in high-risk patients

Hypertension is least likely to be controlled in patients at highest risk of heart attack and stroke despite them being on more medication, according to US research.

A chart review and survey of 613 patients found that patients with moderate and high Framingham scores had greatly reduced odds of achieving control compared with patients with low scores. Being female and having diabetes or impaired fasting glucose also reduced patients' chances of successful treatment, but age and body mass index had no bearing on blood pressure control.

American Journal of Hypertension 2004; 915-20

Traffic exposure triggers heart attack

People who spend a lot of time in the car or on public transport may be increasing their risk of a heart attack, warn German researchers.

An analysis of the records of 691 patients found exposure to traffic was associated with three times the risk of heart attack within the next hour.

The amount of time spent in a car, on public transport, or riding a motorcycle or bicycle was also consistently linked with the onset of heart attack.

New England Journal of Medicine 2004; 351: 1721-30

Understanding diabetes information

Diabetic patients with poor literacy skills benefit more from individual management programmes than those who can read and write, according to a large randomised controlled trial.

Patients with literacy problems who received individualised intensive disease management programmes from a multidisciplinary team were almost three times more likely to meet HbA1c targets than patients managed normally. Patients with good literacy skills had similar odds of glycaemic control however much multidisciplinary intervention they received on top of standard care.

JAMA 2004; 292: 1711-16

High-flow oxygen helps COPD exercise

High flows of humidified oxygen improve exercise performance in patients with COPD, a US study has found. The study of 10 patients with COPD found patients could exercise for nearly two minutes longer on high flows with less dyspnoea, better breathing pattern and lower arterial pressure compared with low oxygen flows.

In addition, oxygenation of the blood was higher while receiving high-flow oxygen at rest and exercise compared with low-flow oxygen.

Chest 2004; 126:1108-1115

Risk factors for near-fatal asthma

The loss of lung elastic recoil and hyperinflation are risk factors for near-fatal asthma, according to a new study.

The Toronto study of 43 asthmatic patients, aged 16 to 49, found a persistent reduction in FEV1 of Ã79 per cent predicted was also a risk factor.

The loss of lung elastic recoil in asthmatic patients was associated with increased age, duration of disease and progressive expiratory airflow limitation, the study found.

Chest, 2004; 126:1138-1146

Multiple drug therapy cuts heart risk

Patients prescribed both a statin and an ACE inhibitor are less likely to have a cardiovascular event than patients prescribed either drug alone, new Greek research shows.

The study of 1,600 patients with coronary heart disease found that after three years 10 per cent of patients prescribed a statin and an ACE inhibitor had suffered a cardiovascular event, compared with 24.5 per cent of patients on an ACE inhibitor alone.

Aggressive statin use in the absence of an ACE inhibitor also substantially reduced cardiovascular events with only 14.5 per cent of patients suffering an event.

Journal of Human Hypertension 2004; 18; 11:781-788

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